FLH Bridge oversized or overload vehicle permit request form Oct 2018.pdf

PDF 145 KB Posted

Attached to
WA NP MORA 123(2) SR-123: Laughingwater Creek Bridge to Panther Creek Bridge
Solicitation number
69056723B000008
Issued by

About this file

This document is a FLH Bridge Oversized/Overweight Permit Load Request Application form. It is used to apply for a permit to move an oversized or overweight vehicle on FLH (Federal Lands Highway) bridges. The form requires the applicant to provide details about the vehicle configuration, dimensions, and weight, as well as the requested route and date of movement. The agency will review the application and either approve or deny the permit, with any applicable conditions. The form includes spaces for a vehicle top view and side view sketch, as well as an axle configuration table. This appears to be a standard administrative form used to manage oversize/overweight vehicle permits on FLH bridges.

The related federal contract opportunity is for a construction project on SR-123 in Washington state, from Laughingwater Creek Bridge to Panther Creek Bridge. The project is part of the WA NP MORA 123(2) solicitation, with the Federal Highway Administration as the contracting agency. No other details about the contract requirements, timelines, or set-asides are provided.

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Text version

Revised 10/9/2018 Page 1 of 2

FLH BRIDGE OVERSIZED/OVERWEIGHT PERMIT LOAD REQUEST

APPLICATION DATE:

APPLICANTS NAME:

COMPANY NAME:

USDOT#:

PHONE NUMBER:

EMAIL ADDRESS:

DESCRIPTION OF LOAD:

DESCRIPTION OF ROUTE:

DATE OF MOVEMENT:

PERMIT VEHICLE CONFIGURATION

WIDTH: HEIGHT: LENGTH:

GROSS WEIGHT:

(COMPLETE VEHICLE CONFIGURATION SKETCH ON NEXT PAGE)

APPLICANTS SIGNATURE: DATE:

(AGENCY USE ONLY)

REVIEWED BY: DATE:

DENIED APPROVED

PERMIT CONDITIONS:

Revised 10/9/2018 Page 2 of 2

VEHICLE TOP VIEW

(w/ dimensions)

VEHICLE SIDE VIEW

(w/ dimensions)

Axle Number TOTAL Axle width (ft) WEIGHT (lbs) Load (lbs) per axle No. of Tires per axle

*Adjacent axles carrying the exact same load, dimensions and tires may be grouped in the axle table

A PERMIT SUBMITTED WITH INCOMPLETE, ILLEGIBLE, OR INCONSISTENT DATA WILL BE RETURNED FOR CORRECTION

TOTAL WEIGHT lbsLoad lbs per axle:
Axle Number:
Axle width ft:
Load lbs per axle:
No of Tires per axle:
Axle Number2:
Axle Number3:
Axle Number6:
Axle Number7:
Axle Number8:
Axle width ft2:
Axle width ft3:
Axle width ft4:
Axle width ft5:
Axle width ft6:
Axle width ft7:
Axle Number4:
Axle Number5:
Axle Number5b:
Axle Number9:
Axle width ft8:
Axle width ft9:
Axle width ft10:
Load lbs per axle2:
No of Tires per axle2:
Load lbs per axle3:
No of Tires per axle3:
Load lbs per axle4:
No of Tires per axle4:
Load lbs per axle5:
No of Tires per axle5:
Load lbs per axle6:
No of Tires per axle6:
Load lbs per axle7:
No of Tires per axle7:
Load lbs per axle8:
No of Tires per axle8:
Load lbs per axle9:
No of Tires per axle9:
Load lbs per axle10:
Check Box1: Off
Permit Condition:
height:
length:
Date1:
Name:
Company name:
USDOT #:
Phone #:
Date3:
Date4:
Date2:
Route:
Load Description:
Email address:
Check Box2: Off
width:
GVW:
No of Tires per axle10:
Top view and side view truck:

File details come from the government source that posted it. Updated .